StrategicPlanforNIH Obesity Research Summary 2011

7/27/2019 StrategicPlanforNIH Obesity Research Summary 2011

1/8

Summary

Strategic Plan ForNIH Obesity Research

March 2011

Introduction Obesity and National Institutes ofHealth (NIH) Research

Obesity is a major contributor to serious health conditions in

children and adults, including type 2 diabetes, cardiovascular

disease, many forms of cancer, and numerous other diseases

and conditions. Individuals who are obese also may experience

stigma and discrimination. Obesity takes a substantial economic

toll due to increased healthcare costs and lost productivity. As

rates of obesity have soared in the past three decades, it is clear

that increasing the number of people who achieve and maintain

a healthy weight is a critical public health goal, although one that

faces formidable challenges. Reducing the prevalence of obe-

sity and its associated health consequences will require broad-

based efforts by government, the private and nonprot sectors,

businesses, community organizations, healthcare professionals,

schools, families, and individuals. Recognizing that simply tell-

ing people to eat less and exercise more is not enough, many

individuals and groups are taking action to decrease the burden

of obesity.

At the foundation of these efforts is research to understand the

causes and consequences of obesity, develop and evaluate new

prevention and treatment strategies, and inform policies. Re-

searchers are trying to answer many questions: How can we

augment and use our knowledge of human biology and behavior

to develop better and more targeted prevention and treatmentapproaches for obesity? What factors in our community environ-

ments and daily lives contribute to unhealthy eating and insuf-

cient physical activity, and what can we modify so that people

could more feasibly attain and maintain a healthy weight? How

can we rigorously evaluate interventionswhether based on

individual lifestyle changes, pharmacological or surgical


2/8

STRATEGIC PLAN FOR NIH OBESITY RESEARCH SUMMARY

2

approaches, community-based programs, lo-

cal or national policy changes, or a combina-

tion o strategiesto determine which really

work, and who could most benet? When and

how do we best intervene to prevent the devel-

opment o obesity? What are the challenges

and opportunities or obesity prevention and

treatment throughout the liespan, rom very

young children to older adults? How do we

reduce health disparities in obesity and its

health consequences? How do we scale up

the approaches that show promise, and imple-

ment or expand those proven eective, to

reach more people? Given that no

single intervention will solve thiscomplex problem, how can we

continue identiying new op-

portunities to spark innova-

tive approaches?

As the nations biomedical

research agency, the National

Institutes o Health (NIH) unds a

broad spectrum o research on obe-

sity. These studies are conducted through-out the country and around the world at

universities, medical centers, and companies,

oten in partnership with schools, businesses,

and other community organizations. The Stra-

tegic Plan for NIH Obesity Research will serve

as a guide to accelerate research to reduce the

prevalence o obesity, so that people can look

orward to healthier lives.

Development of the Strategic Plan

A Multiaceted Approach to a Multiaceted

Problem: Dened as an excess o body at,

obesity develops when there is a disruption o

energy balancethat is, when the number o

calories (energy) consumed in ood and bever-

ages exceeds the number o calories that the

body burns to uel basic lie unctions, physical

activity, and normal childhood growth. A com-

plex interplay o orces contributes to the de-

velopment o obesity, rom our innate biology

to environmental actors such as the charac-

teristics o the neighborhoods in which we live.

Thus, multiaceted approaches are needed to

combat obesity.

New Scientifc Opportunities, Renewed

Commitment to Obesity Research: The cur-

rent Strategic Plan for NIH Obesity Research,

published in 2011, refects both the com-

plexity o obesity and the exciting

opportunities that have emerged

rom research advances since

the NIH published its rst stra-

tegic plan on this major public

health challenge in 2004.

The NIH Obesity Research

Task Force developed the up-

dated Strategic Plan for NIH Obe-

sity Research with crucial input rom

researchers external to the NIH, proes-sional and other health-ocused associations,

scientic societies, healthcare providers, and

the public, representing a broad range o exper-

tise and areas o interest. Research advances

and opportunities published in the scientic lit-

erature and presented at NIH workshops and

national meetings also helped shape the Stra-

tegic Plan and will continue to inorm NIH re-

search planning.

Obesity is characterized by a large excess o body at.A common way to screen or obesity uses body mass

index (BMI), a measure o weight relative to height.

In adults, obesity is dened as a BMI o 30 kilograms/meters2 or greater, and in children and youth as aBMI at or greater than the 95th percentile or age and

gender (based on previous national growth charts).


3/8


3

The Strategic Plan for NIH Obesity Research

is available in two versions. This version is

intended as a non-technical summary. It is a

companion to the full Strategic Plan, which is

targeted to researchers. Both are available on

the NIH Web site at http://obesityresearch.nih.

gov/About/strategic-plan.htm.

Research Opportunities

The Strategic Plan is framed around the

following overarching themes:

l

l

l

l

l

l

Discover fundamental biologic processes

that regulate body weight and inuence

behavior

Understand the factors that contribute to

obesity and its consequences

Design and test new interventions for

achieving and maintaining a healthy weight

Evaluate promising strategies for obesity

prevention and treatment in real-world

settings and diverse populations

Harness technology and tools to advance

obesity research and improve healthcare

delivery

Facilitate integration of research results into

community programs and medical practice

Research to identify and reduce health

disparities is essential to all themes of the

Strategic Plan. Populations at disproportion-

ate risk for obesity include: racial and ethnicminority groups, such as African Americans,

Hispanic/Latino Americans, American Indians/

Alaska Natives, and Pacic Islanders; people

who are socioeconomically disadvantaged and

who have limited access to affordable healthy

foods, safe places for physical activity, and

health care; people with low literacy; and peo-

ple who have physical, intellectual, or develop-

mental disabilities.

Several additional topics span the themes

of the Strategic Plan. An important area is

translational research to bridge scientic dis-

covery to improvements

in public health:

from fundamental

insights gained

in the labora-

tory into inter-

ventions that

can be tested

in clinical trials,

and from results

of clinical studies

into research that ex-

plores implementation in real-world settings.

A number of areas of NIH-supported obesity

research may benet from public-private part-

nerships and other collaborative efforts involv-

ing industries, schools, healthcare providers,

community organizations, other governmentagencies, and other partners. Because obe-

sity is increasing globally, studies in interna-

tional settings may inform the development of

prevention and treatment strategies for people

around the world and in the United States. Fi-

nally, training and reinvigorating a multidisci-

plinary scientic workforce will be essential to

the broad spectrum of research outlined in the

Strategic Plan.

The following pages describe the major themes

of the Strategic Plan in more detail. For each

theme, the highlighted examples of research

topics are intended to be illustrative, rather

than limiting.
http://obesityresearch.nih.gov/About/strategic-plan.htmhttp://obesityresearch.nih.gov/About/strategic-plan.htmhttp://obesityresearch.nih.gov/About/strategic-plan.htmhttp://obesityresearch.nih.gov/About/strategic-plan.htm


4/8


4

Discover fundamental biologic

processes that regulate body weight

and inuence behavior

The extraordinary difculties of preventing

obesity, losing excess weight, and keeping

the pounds off derive, in part, from the

elaborate array of molecular signals

that travel throughout the body

to inuence fat accumulation,

eating behavior, and physical

activity. The genes that en-

code these molecular signals

vary from person to person:

these genetic differences,

which scientists are beginningto discover, make some people

more, and others less, prone to obesi-

ty. Additionally, diet, activity, and aspects of our

environment may modify innate biologic path-

ways in ways that increase, or protect against,

excess body fat. By advancing knowledge of

how body weight and metabolism are normal-

ly regulated, and what goes awry in obesity,

fundamental research discoveries open new

avenues for preventing and treating obesity

and health problems related to excess weight.

This research will identify factors that could be

targeted by new drug development or other

strategies, and it also will enhance the design

of lifestyle interventions that more effectively

address the biologic inuences on peoples

behaviors.

Understand the factors that contributeto obesity and its consequences

In addition to inherent biological factors, other

potential contributors to excess weight gain

include aspects of the environments in which

we live; individual behaviors; and family, social,

and cultural interactions. For example, the

types and costs of foods available in com-

munities, sedentary work and play, media and

marketing messages that surround us, and lo-

cal and national policies can all inuence

dietary choices and physical activity

levels. Eating habits and physical

activity also may change over

time, and vary at different life

stages in children and adults.

Research to better understand

the many factors that contrib-

ute to obesity, and how these

differ among individuals andpopulations will provide insight

into what could be changed to make

environments and policies more conducive to

healthy lifestyles, and to motivate and facilitate

long-term behavior modication.

The consequences of obesity are numerous

and varied. Obesity heightens the risk for

type 2 diabetes, heart disease, many cancers,

and a range of other serious and debilitatinghealth conditions; impairs quality of life in other

ways; and increases healthcare costs. Obesity

may be both a cause and a consequence of

other conditions, such as stress, sleep prob-

lems, depression, and binge eating disorder.

Through research, increased knowledge of the

consequences of obesity, how excess body

fat can lead to disease, and how some people

appear to stay healthy despite their obesity

will facilitate development of more successful

strategies to improve the health of all people

who are obese.


5/8


5

Design and test new interventions for

achieving and maintaining a healthy

weight

Loss of even modest amounts of excess

weight can have dramatic health benets. Pre-

venting obesity is associated with reduced risk

for many serious diseases. However, the high

rates of obesity in adults and children attest

to the difculty of achieving and maintaining a

healthy weight. Thus, it will be important to de-

sign and evaluate a variety of obesity prevention

and treatment approachesboth personalized

and population-based. Examples include strat-

egies to guide parents in providing healthy food

and physical activity for their children; methodsto help adults manage their own weight through

healthier eating, increased exercise, and

decreased sedentary activity; life-

style interventions for achieving

a healthy weight during preg-

nancy, to benet mothers and

their children; and approaches

for maintaining healthy behav-

iors. These types of interven-

tions can take place in a variety

of settingswherever people

spend time, there are opportuni-

ties to promote a healthy lifestyle. Re-

searchers can explore interventions in homes,

schools, workplaces, healthcare settings, and

other community sites. Researchers can also

evaluate broader environmental and policy

changes relevant to food and physical activ-

ity, to see which show promise. For people

who are extremely obese or who already have

an obesity-related illness, lifestyle approach-

es, although vital, may not be enough. Thus,

continued studies of medications and surgi-

cal procedures will be valuable to help inform

treatment decisions. It also will be important

for researchers to determine whether weight

control interventions reduce obesity-related

diseases and improve quality of life.

Evaluate promising strategies for

obesity prevention and treatment in real-world settings and diverse populations

As we nd successful approaches to prevent or

reduce obesity, we can implement them more

broadly, in healthcare practice and community

settings, to benet more people. Research will

guide the development of cost-effective strat-

egies to bring ndings from clinical trials into

real-world settings. In communities, research

to evaluate new and existing policies andgrassroots initiatives will spotlight those that

show success and could be expanded.

When an intervention seems prom-

ising, researchers can develop

and test innovative adapta-

tions for diverse populations

and other settings where im-

plementation may be more

feasible or cost-effective. By

surveying the landscape of

obesity prevalence, neighbor-

hood characteristics, and peoples

health and behaviors, researchers can

identify populations that may have particu-

lar challenges to be addressed. Several av-

enues of study will yield information to help

healthcare providers and their patients make

decisions about weight management. This

research includes comparing the outcomesof different lifestyle, pharmacologic, and sur-

gical interventions, along with other forms of

comparative effectiveness research. It is also

important to ensure that weight control and

related health information is communicated in


6/8


6

meaningul ways. By exploring dierent com-

munication strategies, researchers will improve

ways to give people the health inormation they

need, in terms they understand and that reso-

nate with their own lives.

Harness technology and tools to

advance obesity research and improve

healthcare delivery

Advances in technology and tools will bol-

ster all o the research avenues described in

the Strategic Plan, enhance delivery o health

care, and improve peoples ability to monitor

their own diet and ac-

tivity. Strategies toprevent and treat

obesity would

benet rom

technologies

to make a va-

riety o mea-

sures easible

in real-world set-

tings, more accu-

rate, and cost-eective.

These include measures o body at, what and

how much people are actually eating, how

active or sedentary they are, and what types

o oods and opportunities or physical activ-

ity are available in their neighborhoods. Ad-

vanced tools or collecting and analyzing very

large amounts o data (high-throughput tech-

nologies) and other cutting-edge techniques

will continue to accelerate research progress.

Facilitate integration of research results

into community programs and medical

practice

To maximize the impact o research, the Stra-

tegic Plan highlights education, outreach,

and other eorts to help community leaders,

healthcare proessionals, policymakers, and

the general public make use o research nd-

ings. These include, or example, national ed-

ucation campaigns and programs or diverse

audiences, such as an NIH education program

to reduce childhood obesity called We Can!

Ways to Enhance Childrens Activity & Nutrition.

Additionally, the NIH has developed evidence-

based clinical guidelines and other resourcesto help healthcare providers assist their pa-

tients with weight management. The NIH also

collaborates and coordinates with other agen-

cies and organizations to enhance research,

patient care eorts, education, and outreach.

These eorts will help educate the public, in-

orm policy, and improve health care.

Obesity Trends in the United States

0%

5%

10%

15%

20%

25%

30%

35%

40%

1972 1979 1986 1993 2000 2007

PercentObese

Adults20-74 years of age

Children/Youth2-19 years of age

Year

The prevalence o obesity has increased dramatically over

the past three decades. More than 33 percent o adults and

more than 16 percent o children are currently obese.

(Data from National Health and Nutrition Examination Survey)


7/8


7

Conclusion

The NIH is committed to moving research orward, in order to

provide a sound evidence base or eective actions to prevent

and treat obesity. Importantly, the Strategic Plan for NIH Obesity

Research is intended to be dynamic: NIH research will continuebuilding on emerging discoveries and knowledge, to catalyze the

development o new approaches and to identiy and expand those

that work, so that people can look orward to healthier lives.

Image credits

Parent and child with bicycle: Polka Dot Images/Punchstock

People walking: Getty Images

Cells in body at tissue: Obesity leads to chronic infammation, which is associated with diabetes and other diseases.

This image o at tissue rom an obese mouse shows at cells (blue) surrounded by infammation-promoting cells o the

immune system, called macrophages (green). Image provided by Dr. Carey Lumeng.

Parent and child preparing salad: Punchstock

Person buying healthy ood: Getty Images

Image o mice: This photograph, among the images eatured on the cover o the ull Strategic Plan, illustrates research

on biological actors associated with obesity. Image of mice provided by Dr. Robert A. Waterland and reprinted from

Journal o Pediatrics, 149, Waterland RA, Epigenetic mechanisms and gastrointestinal development, S137-S142,

Copyright 2006, with permission from Elsevier.

Graph o obesity trends in the United States: This graph shows data rom the National Health and Nutrition Examina-

tion Survey (NHANES) o the Centers or Disease Control and Prevention (CDC)/National Center or Health Statistics.

Obesity is dened as body mass index (BMI) greater than or equal to gender- and age-specic 95th percentile rom the

2000 CDC Growth Charts among youth (children/adolescents 219 years o age), and BMI greater than or equal to 30

among adults (2074 years o age). NHANES survey years: 197174, 197680, 198894, 19992000, 20012, 20034,

20056, and 20078.

We Can! Ways to Enhance Childrens Activity & Nutrition, We Can!, and the We Can! logos are registered trademarks o

the U.S. Department o Health and Human Services (HHS).

DISCRIMINATION PROHIBITED: Under provisions o applicable public laws enacted by Congress, no person in the United States

shall, on the grounds o race, color, national origin, religion, gender, or physical or mental disabilities, be excluded rom participa-

tion in, be denied the benefts o, or be subjected to discrimination under any program or activity (or, on the basis o sex, with

respect to any education program or activity) receiving Federal fnancial assistance. In addition, Executive Order 11141 prohibits

discrimination on the basis o age by contractors and subcontractors in the perormance o Federal contracts, and Executive

Order 11246 states that no ederally unded contractor may discriminate against any employee or applicant or employment

because o race, color, religion, sex, or national origin. Thereore, programs covered in the publication must be operated in

compliance with these laws and Executive Orders.


8/8

A REPORT OF THE NIH OBESITY RESEARCH TASK FORCE

U.S. Department of Health and Human Services

National Institutes of Health

NIH Publication No. 11-5493-aNIH Publication No. 11-5493-a

March 2011

Documents

StrategicPlanforNIH Obesity Research Summary 2011